腰硬联合麻醉在高龄产妇剖宫产手术中的临床应用

Clinical Analysis of Lumbar Epidural Anesthesia in Older Mothers with Cesarean Section

目的:探讨腰硬联合麻醉在高龄产妇剖宫产手术中的麻醉效果及安全性。方法:选择ASA分级Ⅰ～Ⅱ级的高龄产妇200例。Ⅰ组选择行硬膜外穿刺,穿刺成功后行蛛网膜下腔穿刺见脑脊液后注射0.75%罗哌卡因2 mL,Ⅱ组选择L2～3硬膜外腔穿刺,确定麻醉效果满意后开始手术。结果:200例高龄产妇的麻醉均获成功,Ⅰ组最高感觉阻滞平面达T4,Ⅱ组达T8;Ⅰ组感觉阻滞范围平均为8±2个节段,Ⅱ组为6±3个节段;Ⅰ组运动阻滞持续时间为143±9 min,Ⅱ组为112±3 min。2组间上述指标的差异均有显著性(P<0.05)。Ⅱ组无肌松或镇痛不满意5例,2组间肌松效果和镇痛质量的差异有统计学意义(P<0.05)。结论:选用腰硬联合麻醉能明显减少高龄产妇剖宫产术中不良反应,并能达到较好的镇痛质量和肌松效果,优于常规的硬膜外麻醉。

Objective：To investigate the anesthetic effect and safety of lumbar epidural anesthesia for cesarean delivery in older mothers.Methods：ASAⅠ～Ⅱ grade 200 cases were of advanced maternal age.Group Ⅰ,underwent successful lumbar spinal puncture after seeing cerebrospinal fluid,had ropivacaine 0.75% 2 ml;Ⅱ group selected L2～3 epidural puncture to determine satisfaction with anesthesia.Results：200 patients with advanced maternal age were successful anesthesia,Ⅰ group had the highest sensory level of T4,Ⅱ group of T8.Sensory block in Ⅰgroup average 8±2 segments,Ⅱgroup 6±3 segments;Ⅰgroup of motor block duration 143±9 min,Ⅱgroup 112±3 min;differences between the two groups were significant（P0.05）.Ⅱgroup without muscle relaxant or pain were unsatisfied with in 5 cases,between the two groups of muscle relaxant and analgesic effect were statistically significant difference（P0.05）.Conclusion：The use of lumbar epidural anesthesia can significantly reduce adverse reactions during cesarean section,and can achieve a better analgesia and muscle relaxation effect,is superior to conventional epidural anesthesia.